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Quine is the first transgender person to get sex reassignment surgery in prison.

SFINX Publishing/The Women of San Quentin

On August 7th, 2015, Shiloh Heavenly Quine’s 56th birthday, she and her longtime partner were hanging out in the day room at Mule Creek State Prison, a men’s facility in Ione, California. All of a sudden, Quine – a transgender woman with dirty blond hair and an infectious smile – was summoned to the program office over the loudspeaker. “I wonder what they want,” Quine remembers thinking. “Well, I haven’t done nothing so I can’t be in trouble.”

When she arrived at the office, a counselor handed her an envelope. Inside, ready for Quine to sign, was a settlement agreement her lawyers had reached with the state of California, which would enable her to access the sex reassignment surgery (SRS, also called gender confirmation surgery) she had fought for and dreamed of for years. This past January, Quine made history when she became the first trans person in America to receive SRS while incarcerated.

In an exclusive interview with Rolling Stone from Central California Women’s Facility, where she was transferred in February, Quine recalls of the moment she heard the news. “I was in shock,” she says over the phone, her voice still brimming with excitement. “Oh my God. I couldn’t believe it.”

That day in August was a turning point in Quine’s life as well as the lives of the estimated 3,200 incarcerated trans people in the United States. Not only that, her settlement marked a new day in the evolution of trans rights in America. It established a precedent that anyone and everyone – even those people the U.S. arguably treats with the greatest distain, its prisoners – have a constitutional right to access comprehensive gender-affirming medical care. By requiring the state to provide her with this surgery, it signified that SRS is not “optional” or elective, but an operation that is both crucial and lifesaving.

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“I felt that, you’re giving surgery to people who need hearts and kidneys, and you’re paying just as much for that for that, for these incarcerated inmates,” says Quine when asked what it was like to fight for her surgery. “So it felt like discrimination. You’ll provide for certain aspects of individuals, but when it comes to transgenders, we’re not worthy.”

Shiloh Heavenly Quine was born in Los Angeles in 1959, and grew up mostly in Arizona with her mother, father and three sisters. “I was a cheerful kid, but I feel I didn’t have a childhood,” she says – her father was abusive, and growing up things were difficult. From an early age, Quine identified as female, and as a child she used to play with the dolls that were lying around her house. Quine’s dad was “pretty hardcore” and had clear expectations of the kind of man he wanted Quine to be.

In eighth grade, Quine participated in a contest called “Weird Day,” where kids could dress up however they liked. She went as a woman, sporting long hair and a dress. “I was able to be myself,” Quine remembers. She won the contest. As the years went on, Quine struggled with her desires to be a woman but tried to brush it off as just a phase.

In 1980, Quine was arrested. By 1981 she had been convicted on charges of first-degree murder, kidnapping and robbery for ransom, and sentenced to serve to life without parole in the custody of the California Department of Corrections and Rehabilitation (CDCR). She and her alleged accomplice were accused of kidnapping and shooting 33-year-old Shahid Ali Baig, a father of three, during a robbery in downtown Los Angeles. She maintains her innocence, claiming she was only convicted because jailhouse informants lied on the stand during her trial in exchange for time cuts on their sentences. (Beginning in 1988, Los Angeles County was rocked by a jailhouse informant scandal, after one informant revealed how he could gather crucial details about a case and use them to fabricate a confession. Quine’s conviction did fall within the time period later investigated by the Los Angeles County District Attorney’s office, however they could not corroborate her account.)

Things on the inside were dangerous. Quine was locked up at the California State Prison, Corcoran during the 1990s – its infamous “gladiator days,” when guards allegedly paired up rival gang members to fight each other, then sometimes shot (and killed) the prisoners to get them to stop. “I didn’t want to come out because I was scared,” says Quine. “I was trying to survive.”

It wasn’t until 2008 that Quine learned she could take hormones and transition while incarcerated. That gave her the push she needed to come out, and she started changing how she dressed and how she looked. Coming out “was the hardest thing I ever did,” Quine says. She was diagnosed with gender dysphoria in October 2008, and in January 2009 she received her first hormone shot. Quine explains that most prisoners responded “very hatefully,” after she started transitioning. “There was very few that would even talk to me.”

The historic nature of Quinn’s surgery is reflective of just how difficult it is for most trans people to receive gender-affirming healthcare on the inside. Flor Bermudez is the Legal Director of the Transgender Law Center (TLC), the largest national trans-led organization in the United States, which, along with the law firm Morgan Lewis, represented Quine. “Our country’s health care system makes it difficult for transgender people across the country to access the health care they need, period,” Bermudez tells Rolling Stone. “When it comes to transgender people in prisons, jails and other institutions, it goes from difficult to almost impossible.” In some places, like Nevada, so-called “freeze-frame” policies are still in place today, meaning trans people cannot access hormones unless they entered prison with a prescription already in hand. Until Quine’s settlement, CDCR – like the vast majority of prison administrations across the U.S. – had a de facto ban on the provision of gender confirmation surgery.

Medical care wasn’t the only issue at hand. Like other trans people behind bars, Quine had to defend herself from physical and sexual violence and frequently ended up in solitary confinement. Denied access to make-up, hygiene items and most women’s clothing, Quine got creative: she made make-up out of Kool-Aid; altered her prison-issued clothing into spaghetti-strapped tops and miniskirts; and eventually got eyeliner and “plucked” eyebrows permanently tattooed on her face.

Even as she got some of the trans-related care she needed, Quine couldn’t stop thinking about SRS. “It was very fulfilling actually to finally complete myself, except I still had this thing between my legs that I felt imprisoned me,” Quine recalls. “I felt like twins that are born together, stuck together and that they needed a procedure at some point to separate them in order to be complete.”

So shortly after she started hormones, Quine filed a health request for SRS. A doctor who worked for CDCR found that she “[was] a good candidate for sexual [sic] reassignment surgery on the basis of medical necessity,” which to Quine seemed like a hopeful step. The doctor’s recommendation was in line with the prevailing medical expertise on trans care, which holds that that SRS is an essential, safe and effective way to relieve gender dysphoria for some trans and gender non-conforming individuals.

CDCR denied her request. When she found out the news, Quine says she tried to commit suicide. “It seemed hopeless,” Quine tells me. “I was at my end, that was it.” But she survived, and decided she would try and fight for her surgery through the courts. She filed a lawsuit, and the judge assigned to her case decided it was strong enough to appoint outside counsel. The Transgender Law Center and Morgan and Lewis came on board.

“That’s when it really got real,” Quine says. “The hope began to turn into a flame, from a little ash.”

The California prison system continued to fight. In a February 2015 court filing, lawyers for the state denied that CDCR discriminates against trans women by enabling cisgender women to more easily access the medical procedure in question (vaginoplasty), and disputed that the only way to treat Quine’s gender dysphoria was through SRS.

In April 2015, a federal judge found that CDCR had violated the Eighth Amendment rights of another transgender woman prisoner, Michelle Norsworthy, and ordered the state to arrange for SRS for her. The ruling was appealed, but soon after, a parole board found Norsworthy eligible for release. Since she was sentenced to life without the possibility of parole, Quine’s sentence left CDCR with no similar option, and just a few months later they settled.

“To understand the impact of this case for people in prison, you need only look at what California did next,” says Bermudez in an email. “[It] establish[ed] the first policy in the country enabling transgender people in prison to access the medical care they need, including surgery.” Requests for surgery must now be approved by the newly formed Sex Reassignment Surgery Review Committee. In order to be eligible, prisoners must meet certain criteria, including having at least two years to serve before their anticipated release or parole date. In October 2015, when the new policy came into force, about 400 or so transgender people stood to benefit, according to numbers released by CDCR.

Quine’s case was not just a win for people on the inside, but also those who are free. “As insurance companies continue to deny health care for trans people across the country, this ruling made clear that gender-affirming surgery can be a life-saving, medically necessary form of care,” says Bermudez. “Supporting Shiloh with this victory has provided a much-needed dose of hope that, little by little, we can tackle the injustice of this system and reclaim the dignity of transgender people in prison.”

In California and across the country, right-wing activists have vocally opposed Quine’s surgery. In February 2017, the conservative California Family Council issued a press release castigating the settlement as a “bizarre reflection of priorities” and an “obvious perversion of the Eighth Amendment.” The organization, which has vocally opposed California’s efforts to support trans and gay school children, lambasted the cost of Quine’s procedure and the impact it might have on the victim’s family. “Not only is this decision a frivolous use of taxpayer dollars, it is prioritizing the feelings and needs of a murderer over those of innocent citizens,” it stated in its press release.

Farida Baig, the daughter of the man Quine was convicted of killing, tried unsuccessfully in court to block her medical procedure. “I’m helping pay for his surgery; I live in California,” Baig told the Associated Press. “It’s kind of like a slap in the face.” Asked if she was ever angry at Baig for her comments, Quine doesn’t even pause. “No, not even a little bit. Naw, how could I be angry at her? She lost her father.”

According to CDCR, thus far five individuals have been approved for surgeries through the Correctional Health Care Services (CCHCS) SRS Review Committee. Two people have received bilateral mastectomies, which is the procedure CDCR has made available for transgender men. Two other trans individuals held in CDCR custody were approved for SRS, but their surgeries have not yet been completed.

Outside of California, the impact of Quine’s suit for incarcerated trans people has been largely symbolic. “Successful court cases help shift the norms and practices,” says Chase Strangio, a staff attorney with the ACLU’s LGBT and AIDS project, explaining that policy changes will still need to be fought jurisdiction by jurisdiction. Only a federal Supreme Court ruling on blanket policies barring SRS could change prison policies nationwide.

What Quine’s win has provided to incarcerated trans people is a renewed sense of hope. “Shiloh Heavenly Quine is my heroine, my inspiration,” says Geri Erwin, a trans woman incarcerated in New York. “Which empowers me to commit myself to this last battle of my [own SRS] fight.”

Michelle Angelina, a trans woman incarcerated in New Jersey, echoes Erwin’s words. “I would tell Shiloh that I am immensely grateful to her for fighting for her surgery and seeing it through.”

Quine’s groundbreaking legal win comes at a time when trans rights are under attack across the United States. Several state legislatures have attempted to pass “bathroom bills” prohibiting trans or gender nonconforming people from using the restrooms that match their gender identity. In July, President Trump announced his plan to revive the ban on transgender members in the military.

“The denial of healthcare for transgender individuals in custody is just a part of the larger government structures designed to control and erase trans bodies and lives,” says Strangio, who has led litigation efforts against the bathroom bills and the military ban. “The mechanisms for doing so vary, but the goal is always the same: control access to public space for trans people, criminalize trans bodies (particularly poor trans women of color), restrict health care access and ultimately, expel trans people form public life.”

The CDCR and TLC have continued to litigate aspects of the settlement, including whether trans women held in male facilities should have access to bracelets, earrings, hairbrushes and other personal items. CDCR has claimed these items pose a security threat, despite the fact that they are available in women’s prisons. The Ninth Circuit will hear the case in 2018.

“Consistent with the settlement agreement, CDCR has promulgated emergency regulations allowing transgender inmates and inmates with gender dysphoria access to the agreed upon property that corresponds to their gender identity,” says Terry Thornton, Deputy Press Secretary at CDCR.

For Quine, focusing on trans rights has been the drive to keep her fighting. “It was like a calling within me that was so powerful that it kind of went against everything that was logical, especially in the environment that I’m in,” she says. “But yet, it was a drive, something that you’re born with that just…” she pauses. “You want to complete yourself.”